Procedural Complications Involving the Laser Balloon

2021 ◽  
Author(s):  
Jian Liang Tan ◽  
Justin Z. Lee ◽  
Luis R. Scott ◽  
Andrea M. Russo
Keyword(s):  
Procedural Complications ◽  
Laser Balloon

scholarly journals Cryoballoon Versus Laserballoon: Insights from the First Prospective Randomized Balloon Trial in Catheter Ablation of Atrial Fibrillation

2021 ◽  
Author(s):  
Julian K.R. Chun ◽  
Stefano Bordignon ◽  
Jana Last ◽  
Lukas Mayer ◽  
Shota Tohoku ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Antiarrhythmic Drugs ◽  
Fluoroscopy Time ◽  
Office Visits ◽  
Phrenic Nerve Palsy ◽  
Procedural Complications ◽  
Secondary Endpoints ◽  
To Receive ◽  
Laser Balloon

Background - Pulmonary vein isolation (PVI) represents the cornerstone in atrial fibrillation ablation. Cryoballoon (CB) and laser balloon (LB) catheters have emerged as promising devices but lack randomized comparisons. Therefore, we sought to compare efficacy and safety comparing both balloons in patients with persistent and paroxysmal AF. Methods - Symptomatic AF patients (n=200) were prospectively randomized (1:1) to receive either CB or LB PVI (CB: n=100: 50 PAF + 50 persistent AF vs. LB: n=100: 50 PAF + 50 persistent AF). All antiarrhythmic drugs (AAD) were stopped after ablation. Follow-up included 3-day Holter-ECG recordings and office visits at 3, 6 and 12 months. Primary efficacy endpoint was defined as freedom from atrial tachyarrythmia (ATa) between 90 and 365 days after a single ablation. Secondary endpoints included procedural parameters and peri-procedural complications. Results - Patient baseline parameters were not different between both groups. In all (n=200) complete PVI was obtained and the entire follow-up accomplished. Balloon only PVI was obtained in 98% (CB) vs. 95% (LB) requiring focal touch up in 2 and 5 patients, respectively. Procedure but not fluoroscopy time was significantly shorter in the CB group (50.9±21.0min vs. 96.0±20.4 min; p<0.0001 and 7.4±4.4 min vs. 8.4±3.2min, p=0.083). Overall, the primary endpoint of no ATa reccurence was met in 79% (CB: 80.0% vs LB: 78.0%, p=ns). No death, atrio-esophageal fistula, tamponade or vascular laceration requiring surgery occurred. In the CB group, 8 transient but no persistent phrenic nerve palsy (PNP) were noted compared to 2 persistent PNP and 1 TIA in the LB group. Conclusions - Both balloon technologies represent highly effective and safe tools for PVI resulting in similar favorable rhythm outcome after 12 months. Use of the cryoballoon is associated with significantly shorter procedure but not fluoroscopy time.

Study of Post Procedural Complications Associated with Voiding Cystourethrography

2007 ◽  
Vol 11 (1) ◽  
pp. 65 ◽  
Author(s):  
Min Sun Kim ◽  
Seung Hyun Lee ◽  
Jeong Hwa Kim ◽  
Young Bum Chang ◽  
Dae-Yeol Lee
Keyword(s):  
Voiding Cystourethrography ◽  
Procedural Complications

Real-life Bifurcation – Challenges and Potential Complications

2011 ◽  
Vol 7 (4) ◽  
pp. 283
Author(s):  
Inga Narbute ◽  
Sanda Jegere ◽  
Indulis Kumsars ◽  
Dace Juhnevica ◽  
Agnese Knipse ◽  
...  
Keyword(s):  
Stent Thrombosis ◽  
Real Life ◽  
Coronary Intervention ◽  
Side Branch ◽  
The Body ◽  
Chronic Total Occlusions ◽  
Vein Grafts ◽  
Procedural Complications ◽  
Drug Eluting ◽  
Bifurcation Lesions

Together with calcified lesions, saphenous vein grafts, chronic total occlusions and unprotected left main lesions, bifurcation lesions are complex lesions that remain among the outstanding challenges of treatment with percutaneous coronary intervention. Bifurcation lesions are associated with increased rates of procedural complications, restenosis and adverse events than lesions in the body of the vessel. The introduction of drug-eluting stents for the treatment of bifurcation lesions has dramatically decreased restenosis rates, especially in patients suffering from diabetes. However, abrupt side branch closure, side branch ostial restenosis and stent thrombosis remain areas where further improvement is needed. Although a provisional T-stent strategy is most often used when side branch stenting is required, there are true bifurcation lesions where the selected use of more complex bifurcation approaches (such as the crush technique, T-stenting or the culotte technique) seem appropriate, particularly when the main branch and side branch are larger vessels with more diffuse side branch disease. The major challenge with any technique is to ensure that the side branch is protected and there is a satisfactory final result. Many technical questions rise in trying to ensure this outcome and lower the risk of intra- and post-procedural complications such as side branch closure and restenosis, stent thrombosis, dissection and fracture of a jailed wire: how can difficult side branch access be solved? How can unfavourable side branch anatomy be re-wired after main vessel stent placement? How can fracture of a jailed wire be avoided? Is side-strut dilation beneficial?

Use of a Diode Laser Balloon Ablation Catheter to Generate Circumferential Pulmonary Venous Lesions in an Open-Thoracotomy Caprine Model

2004 ◽  
Vol 27 (1) ◽  
pp. 52-57 ◽  
Author(s):  
VIVEK Y. REDDY ◽  
CHRISTOPHER HOUGHTALING ◽  
JAY FALLON ◽  
GWEN FISCHER ◽  
NORM FARR ◽  
...  
Keyword(s):  
Diode Laser ◽  
Ablation Catheter ◽  
Open Thoracotomy ◽  
Balloon Ablation ◽  
Laser Balloon Ablation ◽  
Laser Balloon

scholarly journals Clinical Applications of Laser Technology: Laser Balloon Ablation in the Management of Atrial Fibrillation

Micromachines ◽  
2021 ◽  
Vol 12 (2) ◽  
pp. 188
Author(s):  
Jamario R. Skeete ◽  
Jeanne M. Du-Fay-de-Lavallaz ◽  
David Kenigsberg ◽  
Carlos Macias ◽  
Jeffrey R. Winterfield ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Laser Energy ◽  
Clinical Applications ◽  
Ablation Techniques ◽  
Cryoballoon Ablation ◽  
Laser Technology ◽  
Balloon Ablation ◽  
Established Role ◽  
Laser Balloon Ablation ◽  
Laser Balloon

Catheter-based ablation techniques have a well-established role in atrial fibrillation (AF) management. The prevalence and impact of AF is increasing globally, thus mandating an emphasis on improving ablation techniques through innovation. One key area of ongoing evolution in this field is the use of laser energy to perform pulmonary vein isolation during AF catheter ablation. While laser use is not as widespread as other ablation techniques, such as radiofrequency ablation and cryoballoon ablation, advancements in product design and procedural protocols have demonstrated laser balloon ablation to be equally safe and effective compared to these other modalities. Additionally, strategies to improve procedural efficiency and decrease radiation exposure through low fluoroscopy protocols make this technology an increasingly promising and exciting option.

scholarly journals B-PO02-073 ONE-YEAR FOLLOW-UP AFTER WIDE-AREA PULMONARY VEIN ISOLATION USING THE VISUALLY GUIDED LASER BALLOON FOR ATRIAL FIBRILLATION

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S125-S126
Author(s):  
Takashi Yamasaki ◽  
Tetsuhisa Hattori Keisuke Ohta ◽  
Nobuyuki Miyai, Reo Nakamura ◽  
Takayoshi Sawanishi Noriyuki Kinosita ◽  
Ken Kakita
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Wide Area ◽  
Visually Guided ◽  
One Year ◽  
Laser Balloon

Bridging versus direct endovascular therapy in basilar artery occlusion

2021 ◽  
pp. jnnp-2020-325328
Author(s):  
Sergio Nappini ◽  
Francesco Arba ◽  
Giovanni Pracucci ◽  
Valentina Saia ◽  
Danilo Caimano ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Basilar Artery ◽  
Endovascular Therapy ◽  
Recombinant Tissue Plasminogen Activator ◽  
Artery Occlusion ◽  
Lower Mortality ◽  
Basilar Artery Occlusion ◽  
Bridging Therapy ◽  
Procedural Complications

BackgroundWe evaluated safety and efficacy of intravenous recombinant tissue Plasminogen Activator plus endovascular (bridging) therapy compared with direct endovascular therapy in patients with ischaemic stroke due to basilar artery occlusion (BAO).MethodsFrom a national prospective registry of endovascular therapy in acute ischaemic stroke, we selected patients with BAO. We compared bridging and direct endovascular therapy evaluating vessel recanalisation, haemorrhagic transformation at 24–36 hours; procedural complications; and functional outcome at 3 months according to the modified Rankin Scale. We ran logistic and ordinal regression models adjusting for age, sex, National Institutes of Health Stroke Scale (NIHSS), onset-to-groin-puncture time.ResultsWe included 464 patients, mean(±SD) age 67.7 (±13.3) years, 279 (63%) males, median (IQR) NIHSS=18 (10–30); 166 (35%) received bridging and 298 (65%) direct endovascular therapy. Recanalisation rates and symptomatic intracerebral haemorrhage were similar in both groups (83% and 3%, respectively), whereas distal embolisation was more frequent in patients treated with direct endovascular therapy (9% vs 3%; p=0.009). In the whole population, there was no difference between bridging and direct endovascular therapy regarding functional outcome at 3 months (OR=0.79; 95% CI=0.55 to 1.13). However, in patients with onset-to-groin-puncture time ≤6 hours, bridging therapy was associated with lower mortality (OR=0.53; 95% CI=0.30 to 0.97) and a shift towards better functional outcome in ordinal analysis (OR=0.65; 95% CI=0.42 to 0.98).ConclusionsIn ischaemic stroke due to BAO, when endovascular therapy is initiated within 6 hours from symptoms onset, bridging therapy resulted in lower mortality and better functional outcome compared with direct endovascular therapy.

scholarly journals Percutaneous dilatational tracheotomy in high-risk ICU patients

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
E Luesebrink ◽  
S Massberg ◽  
M Orban
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
High Risk ◽  
Triple Therapy ◽  
Bleeding Risk ◽  
Icu Patients ◽  
Procedural Complications ◽  
Multivariable Regression ◽  
International Multicenter Study ◽  
International Multicenter

Abstract Funding Acknowledgements Type of funding sources: None. Background Percutaneous dilatational tracheotomy (PDT) has become an established procedure in cardiac intensive care units (ICU). However, the safety of this method has been under debate given the growing number of critically ill patients with high bleeding risk receiving anticoagulation, dual antiplatelet therapy (DAPT) or even a combination of both, i.e. triple therapy. There is a need for critical evaluation of these safety concerns. This is the first and largest international, multicenter study on PDT to date including such a high proportion of patients on antithrombotic therapy investigating whether PDT in high-risk ICU patients is associated with elevated procedural complications and analysing risk factors for bleeding occurring during and after PDT. Methods PDT interventions conducted in ICUs at 12 European sites between January 2016 and October 2019 were retrospectively analysed for procedural complications. For subgroup analyses, patient stratification into clinically relevant risk groups based on anticoagulation and antiplatelet treatment regimens was performed. Procedure-related complications for each risk group were analysed until hospital discharge. Additionally, predictors of bleeding occurrence were analysed by uni- and multivariable regression models. Results In total, 671 patients receiving PDT according to Ciaglia’s technique with accompanying bronchoscopy were included. Patients were stratified into seven clinically relevant antithrombotic treatment groups. Within the whole cohort, 74 (11%) bleedings were reported to be procedure-related, none of which required surgical intervention. In almost all cases bleedings were associated with skin bleedings from the entry site and could easily be treated with minimally invasive stitching. Subgroup analysis showed no increase in the rate of procedure-related complications in patients with elevated body mass index. In a multivariable regression model bleeding occurrence during and after PDT was independently associated with platelet count (Odds ratio [OR] 0.73, 95% confidence interval [95% CI] [0.56, 0.92], p = 0.009), chronic kidney disease (OR 1.75, 95% CI [1.01, 3.03], p = 0.047) and previous stroke (OR 2.13, 95% CI [1.1, 3.97], p = 0.02). Neither PTT (OR 1.01, 95% CI [0.99, 1.02], p = 0.32), nor DAPT (OR 1.11, 95% CI [0.56, 2.04], p = 0.75) nor triple therapy (OR 0.93, 95% CI [0.49, 1.66], p = 0.82) were associated with bleeding risk. Conclusion In this international, multicenter study bronchoscopy-guided PDT was a safe and low-complication airway management option, even in a cohort of high risk for bleeding on cardiovascular ICUs. Platelet count, chronic kidney disease and previous stroke were identified as independent risk factors of bleeding during and after PDT whereas DAPT and triple therapy had no influence on bleeding events.

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